As a practicing medical oncologist and breast cancer specialist for decades, one year into the pandemic, I find myself answering almost as many questions about COVID-19 as I do about breast cancer, as my recent patient calls illustrate, and which I would like to share for the purpose of this story only, and not as specific medical advice for anyone who may be reading. (ASCO offers COVID-19 resources for physicians and patients.)
Call 1: My phone rings. It is a patient of mine, Ms. A.
“Doctor, I tested positive for COVID today. What should I do?”
“What are your symptoms?”
“I had a sore throat and mild running nose 4 days ago. I thought it was just a common cold. Yesterday my temperature was 38.5C. I had a PCR test done. It came back as positive today. Doctor, I am scared. Please tell me, what should I do?”
“Well, it looks like your case is mild. Do you have any cough?”
“Do you have any difficulty breathing?”
“That is reassuring! When was your last chemotherapy session?”
“10 days ago.”
Now I start to worry. “Did I give you injections to boost your immunity?”
“Yes, doctor, you gave me 5 daily injections under the skin 2 days after chemo, and my last dose was 2 days ago.”
I felt comfortable that she should not have neutropenia and if her COVID case gets worse she would have a good WBC count. “Just keep drinking lots of fluids,” I advise. “Keep eating well. Nourishment is very important. Take 2 tablets of paracetamol for fever. Take vitamin D once daily.”
“Doctor, should I take vitamin C and zinc? Everybody is telling me to do so to strengthen my immune system.”
“Yes, you can. Vitamin C, Vitamin D, and zinc should help you fight the virus.” I say to myself, why not! Vitamin supplements wouldn’t hurt anyway.
“Doctor, do I need to come see you in the clinic, or see my family doctor, or go to the emergency room?”
“No, you don’t. Get a pulse oximeter and check your O2 saturation. If your oxygen falls below 95% you will need O2. Let me know if you get any shortness of breath, or if your O2 saturation falls below 92%. That is then when you should call the ambulance and go to the emergency room. By the way, don’t go to work and stay confined and isolated at home.”
Call 2: I have just wrapped up my call with Ms. A. when the phone rings again. It is another patient, Mrs. B.
“Doctor, my sister got COVID. I’m worried. I have a cough. What do I do?”
“How sick is your sister? And for how long?”
“She has had a cough, fever, and body aches for the past 3 days.”
“When did you see her last?”
“5 days ago.”
“Is anyone else in the family sick?”
“Yes, my brother has muscle aches and he says he just lost his senses of taste and smell.”
I confirm the last time Mrs B. had chemotherapy—1 year ago. I scratch my head. Should I give her anything else other than the “kitchen recipe” of vitamin C, vitamin D, and zinc tablets? Hydroxychloroquine? Definitely not.
She then asks me about ivermectin. “I heard about it in the news, should I take it? Do you recommend it?” We recently heard data that the anti-parasitic drug ivermectin may work during the viral phase. I don’t say no. “You may take it, as long as you are not pregnant or breastfeeding, and you do not have asthma or liver disease. It may help. There are different opinions about it. The FDA said it does not have enough data to recommend it or not to recommend it."
Call 3: Some patients we recognize and remember right away; with others, we need to remind ourselves who they are. This was the case with my next call.
“Hi, Doctor El Saghir. I am sorry I am calling you in the evening, but I feel very weak and I have fever of 38C with a little bit of diarrhea. I had a walk-in PCR and I tested positive for COVID.”
Her voice is familiar, but I could not remember who she was! I need to ask some clarifying questions. “Please remind me how old have you become?”
“I am 57 years old.”
“When was the last time you had a blood test?”
“6 months ago.” By now, I am reassured she’s not currently on chemotherapy.
“What medications are you on, and for how long?”
“Letrozole, for 2 years.”
“Can you please remind me of your last name?”
“I am Mrs. C.”
Oh yes! Mrs. C. Now I remember. “I haven’t seen you for a while! When did all your new symptoms start?”
“About 10 days ago I started to have muscle aches and a running nose.”
“As long as you do not have any shortness of breath, keep drinking plenty of fluids and stay well hydrated. Eat well. Are you taking vitamin D?”
“Yes, Doctor, you gave it to me with the letrozole to keep my bones strong.”
“I am also taking vitamin C. Is that good?”
“Yes, very good. By the way, women generally do better than men when it comes to COVID complications. I am going to ask you to stop letrozole tablets for one week, until you recover from COVID. That would allow you to have some circulating female hormones.”
Call 4: My fourth call is a patient I saw many years ago.
“Hello, Doctor! I am Mrs. D. You treated me for breast cancer 3 years ago. Should I take the COVID vaccine?”
“Yes, of course you should.”
“But I am afraid it might affect my DNA and dormant cells should I still have any in my body.”
“Don’t worry. It does not get into your DNA. It goes inside the muscle in your arm. It makes your muscle cells make the coronavirus spike protein S and then it gets degraded right away. It wouldn’t survive at your body temperature anyway. Your immune system makes antibodies against the spike protein S and would protect against coronavirus if you get in contact with it."
“Oh great! Thank you, doctor!”
Every day, late afternoon, my nurse, Latifa Shihab, tells me that so many patients have been calling all week, because they have COVID, or a family member has COVID, or more recently to ask about vaccines. Many patients ask which vaccine they should take. I am so grateful for the care and counsel she provides to our patients. Latifa, please keep telling them to take whichever vaccine they can get, and as soon as possible!